Provider Demographics
NPI:1538156112
Name:PETERS, BETTY S (MSN FNP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:S
Last Name:PETERS
Suffix:
Gender:F
Credentials:MSN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 SAN FELIPE RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71909-8893
Mailing Address - Country:US
Mailing Address - Phone:501-321-4362
Mailing Address - Fax:
Practice Address - Street 1:3560 HWY 7N
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71909-6503
Practice Address - Country:US
Practice Address - Phone:501-318-9853
Practice Address - Fax:501-318-6175
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOS00642Medicare UPIN